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NCAFP Administrative Burden Survey Results Summary
ADVOCACY
By Gregory K. Griggs, MPA, CAE
NCAFP Executive Vice President
NCAFP Administrative Burden Survey
Outcomes and Next Steps
Introduction
Many NCAFP members recently completed a survey on administrative burdens family physicians face in practice. Everyone knows that administrative burdens have increased in healthcare, but the questions centered around the biggest pain points and key actions the NCAFP can take on a state level.
We asked and you answered. Here are some of the survey’s findings and the actions the NCAFP Advocacy Committee is recommending to the NCAFP Board as we move forward to address these results. (NOTE: At the time of this writing, the board had yet to meet and fully address the survey results and recommendations, but we wanted to share a preliminary update with our members as soon as possible. This article was in press at the time of the next scheduled Board Meeting on August 7th.)
Key Findings
Here are some of the key findings of the NCAFP member survey on Administrative Burden:
What is the top area of frustration in your practice as it relates to administrative burden?
1) Electronic Medical Records
(Ranked first by 38% of members)
2) Prior Authorizations
(Ranked first by 27% of members)
• Family physicians in rural areas were more likely to list Prior Authorizations as their top area of frustration compared to their urban colleagues.
• Family physicians in private practice were more than twice as likely to list Prior Authorizations as their top frustration compared to those family physicians working in hospital/health systems.
• Conversely, family physicians in urban areas or with hospital/health systems were much more likely to list EMRs as their top area of frustration.
What takes the most time away from patient care?
1) Electronic Medical Records
(Ranked first by 61% of respondents.)
2) Prior Authorizations
(Ranked first by 16% of respondents)
• EMRs were universally ranked as the area taking time away from seeing patients.
• While prior authorizations ranked second across all practice settings, rural physicians and private practice physicians were more likely to rank prior auths higher in terms of taking time away from patient care.
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What one area can the NCAFP focus on to help with administrative burden?
This question offered some more nuanced responses from our members, but there are still clear takeaways:
1) Elimination of prior authorizations based on a performance threshold. (31.5%)
2) Interoperability of medical records and data exchange. (23%)
3) Move away from fee-for-service toward a bundled payment for core primary care services (per member, per month payment). (21%)
• Reduce and align quality metrics among payers. (17%)
• Eliminating prior authorizations based on a performance threshold was the top area for
NCAFP to focus on regardless of practice setting.
• Overall, interoperability of EMRs and moving away from fee-for-service were ranked very closely in the second and third area of focus for most settings. However, private practices were not as likely to focus on moving away from fee-forservice to value-based care; they were more likely to ask for more focus on aligning quality metrics.
Define Administrative Burden in One Sentence
While respondents were not required to answer this question, over 95 percent did, resulting in some of the most heartfelt information we obtained from the survey.
• Numerous comments focused on administrative burden as what takes family physicians away from providing true direct patient care, with one respondent describing it as “paperwork that gets in between me and my patient.” • Several of the comments are heart wrenching, such as “I would love my job 10 times more and could see twice as many patients if it weren’t for the excessive administrative burden that pecks away at my soul.”
• And a few respondents asked questions about the evidence base around whether all the documentation truly improves care.
Next Steps – Moving Forward
As always, it is one thing to gather information, and something totally different to try to utilize that information to impact change. While the NCAFP Board will ultimately decide on next steps (as noted above), here are a few of the recommendations from the committee that reviewed the survey results in detail:
1) Develop education on how to more effectively and efficiently use EMRs, such as a workshop featuring super users teaching how to customize and optimize Electronic Medical Records.
2) Continue NCAFP’s involvement in groups to better align quality metrics across payers. NCAFP Immediate Past President Dr. David Rinehart, NCAFP Secretary-Treasurer Dr. Shauna Guthrie
and NCAFP EVP & CEO Greg Griggs are all participating in a work group convened by the Duke-Margolis Health Policy Center examining ways to align quality metrics in our state. All of the state’s major payers are involved in this working group.
3) Present the survey results to key health insurance companies in North Carolina.
4) Discuss a set of possible options to mitigate the administrative burden of Prior Authorizations with our state’s insurance companies, including:
• Paying primary care a small fee for the time it takes to complete a prior auth;
• Developing “gold card” policies for primary care practices that have a certain percentage of prior-auths approved or who are entering into value-based contracts;
• Developing a prior authorization sunset program to eliminate certain prior auths if auto-approval exceeds a certain threshold;
• Requiring that a peer-to-peer be with a physician (versus other clinician) when there is an appeal; and
• Sharing data with NCAFP on the approval rate for the top-10 medications that require a prior authorization and are prescribed routinely by primary care, as well as the top imaging studies requested by primary care.
These are just a few of the initial ideas as the NCAFP moves forward on the quest to try to simplify the lives of our state’s family physicians. If you have other ideas or thoughts, please do not hesitate to reach out to NCAFP EVP & CEO Greg Griggs at ggriggs@ncafp.com.
